Amazing Detail on New Health Care Reform

[Peazoup]

I had the occasion to visit the Urgent Care facility next to Sweetbay the other day and thought I'd pass on some information that was told to me by a doctor practicing there. I've been diagnosed with arthritis and am on borrowed time before a knee replacement will be necessary. As I'm trying to delay that day, I went in for a little relief via a cortizone shot.
The doctor told me that I probably shouldn't wait much longer as when the new Health Care Reform becomes effective in 2014, joint replacement surgery will be viewed as elective surgery and, therefore, not covered. Do you believe that after paying into our system all our working lives, this will happen to us? Is it really true? Does anyone have anymore info?

[Xavier]

I had the occasion to visit the Urgent Care facility next to Sweetbay the other day and thought I'd pass on some information that was told to me by a doctor practicing there. I've been diagnosed with arthritis and am on borrowed time before a knee replacement will be necessary. As I'm trying to delay that day, I went in for a little relief via a cortizone shot.
The doctor told me that I probably shouldn't wait much longer as when the new Health Care Reform becomes effective in 2014, joint replacement surgery will be viewed as elective surgery and, therefore, not covered. Do you believe that after paying into our system all our working lives, this will happen to us? Is it really true? Does anyone have anymore info?

If it turns out NOT to be true, as I suspect, I'd find me a doctor with more integrity and report him to the state medical regulatory agency.

[actor]

I had the occasion to visit the Urgent Care facility next to Sweetbay the other day and thought I'd pass on some information that was told to me by a doctor practicing there. I've been diagnosed with arthritis and am on borrowed time before a knee replacement will be necessary. As I'm trying to delay that day, I went in for a little relief via a cortizone shot.
The doctor told me that I probably shouldn't wait much longer as when the new Health Care Reform becomes effective in 2014, joint replacement surgery will be viewed as elective surgery and, therefore, not covered. Do you believe that after paying into our system all our working lives, this will happen to us? Is it really true? Does anyone have anymore info?

That's nonsense.

[mac9]

Joint replacement surgery is CURRENTLY considered elective surgery which is why pre-authorization is required. Was is actually a doctor who told you that or a physician's assistant or someone else who works in the office? They should be chastised for starting/passing on such nonsense.
How do I know this? I have had two knee replacements and it was carefully explained to me by both my physician and my insurance company as I did not believe that it was elective.

[Russ_Boston]

Joint replacement surgery is CURRENTLY considered elective surgery which is why pre-authorization is required. Was is actually a doctor who told you that or a physician's assistant or someone else who works in the office? They should be chastised for starting/passing on such nonsense.
How do I know this? I have had two knee replacements and it was carefully explained to me by both my physician and my insurance company as I did not believe that it was elective.

Not sure how you view it as nonsense. If elective surgery wouldn't be covered under the new plan then knee replacement wouldn't be. Right? If that's the case (I'm not sure about the new rules) then the only thing to chastise the doc or PA for would be that they didn't emphasize that knee replacements are currently elective.

I guess the real thing to find out: was the doc right? Will elective surgery not be covered? If that's not the case then chastise away!

[REH7380]

I have been to this Urgent care a couple of times as has my wife. They are by far the best in The Villages and to dismiss them when they tried to alert the patient is outrages. They were trying to help. The patient has options one of which is to go to another Dr. or do research on their own.
Since the Dr at the Urgent Care does not do knee surgery the only motive would be to help the patient.
Who has read the Health Care Reform act? Who understands what it states?
My guess is that very very very few in The Villages understands it and the patient should be grateful that the Dr. took the time to mention it. My only concern is that this type of negative behavior by "knocking the Dr" may lead them to not help with additional advise in the future. Fortunately I know the Dr.'s at this Urgent Care and they will always continue to do what is best and professional for the patient and not be influenced by those that make it entertainment to try to harm the good reputation of a Doctor. :mad:

[l2ridehd]

Please read the bill that has been passed. Today knee replacement is elective and when approved is paid for by insurance. Under the bill as currently passed. elective surgery is not covered and would require some type of a supplemental policy to have elective surgery covered. I doubt anyone knows what the cost of that policy will be as they have not yet been required. My guess would be that this is still a place where insurance companies could still make a profit so probably not cheap. The doctor at the urgent care was accurate in what he told you. Maybe didn't go as far as he should have by telling you today you need approval.

The difference is today you need approval, usually fairly easy to get, tomorrow you will either pay for out of pocket or buy supplemental insurance at some currently unknown cost. Based on that, if you know for sure your going to require it, I would do it sooner vs later. I am getting every test, check up, physical, that I think I may need in the next 5 years done now where I know the rules. May be better or worse in the future, but at least now I know what to expect and don't need to deal with a government run system.

[REH7380]

12ridehd..Thanks for taking the time and opening yourself up to naysayers in order to pass on education. As the guy said in the movies to the naysayer, "you can't take truth"..Denial is a terrible attribute. :angel:

[Xavier]

Please read the bill that has been passed. Today knee replacement is elective and when approved is paid for by insurance. Under the bill as currently passed. elective surgery is not covered and would require some type of a supplemental policy to have elective surgery covered. I doubt anyone knows what the cost of that policy will be as they have not yet been required. My guess would be that this is still a place where insurance companies could still make a profit so probably not cheap. The doctor at the urgent care was accurate in what he told you. Maybe didn't go as far as he should have by telling you today you need approval.

The difference is today you need approval, usually fairly easy to get, tomorrow you will either pay for out of pocket or buy supplemental insurance at some currently unknown cost. Based on that, if you know for sure your going to require it, I would do it sooner vs later. I am getting every test, check up, physical, that I think I may need in the next 5 years done now where I know the rules. May be better or worse in the future, but at least now I know what to expect and don't need to deal with a government run system.

What pages of the bill will I find this information? My primary becomes my secondary when I turn 65. I think, just maybe, your brush is a bit broad.

Lou Card hit the nail on the head again. We'll all have to wear hard hats just in case the sky really is falling! I think not. I've got too much to do than sit around and worry about this story book stuff. Hey did ya hear about the world coming to a stand still when the new millennium starts? (Sorry - couldn't help myself)

X

[chachacha]

in the sand is not the same as looking on the bright side of life!

[chachacha]

the complete post was "burying your head in the sand is not the same as looking on the bright side of life" in fact it must be pretty dark down there!
baa daa boom!

[Peazoup]

Thank you RussBoston, REH7380, 12ridehd and others who took this information as something perhaps to look into more deeply and not to negatively pass judgement. As mentioned, the doctors at Urgent Care have no incentive to advise patients on issues relating to the new health care reform other than to try and protect them against rising costs in the future. In my experience, these doctors are thorough and caring professionals and we should be thankful for such advice.

[Lou Card]

:shocked:

[Autoshow]

If it turns out NOT to be true, as I suspect, I'd find me a doctor with more integrity and report him to the state medical regulatory agency.

I think that Dr. is looking for more business,immediatly

[Russ_Boston]

I think that Dr. is looking for more business,immediatly


With the shortage of physicians - not likely. No physician I know (I'm an RN) is looking for any more business. Our practice has all the patients we need thank you.

[clekr]

I recall reading an article early on in the debate that said the Administrations' proposal was that joint replacement surgury would not be available to persons 65 or older. Remember it's essentially "rationed care".

[Lou Card]

I agree with Russ. My guess would be that the Doctor is worried more about his salary being cut into with the New Health care Plan. For sure he is only speculating about what will take place in 2014 and should not pass on fear to his patients. For every doctor thats feels less treatment will be available to patients, there is an equal number that feels health care will be more available for more procedures. Clearly, they all cannot be right nor can they all be wrong, so again, non factual opinions are speculations and should be avoided and doctors should treat patients in the office and stay away from crystal ball speculation. I don't want to hear their opinion no matter what side of the fence they sit on. Nor do I want their opinion on how fast I should change my faith from Christian to Muslim before the end comes if I want to see the kingdom. If they feel strong about their speculations, get on the stump and shout it out, but not when they are taking my blood pressure.

Lou

[TrudyM]

I know two people who had this surgery. One when she was 62 another when she was 68 both say that they wish they had not put it off ( they both waited until they couldn't walk without pain ) as their increased quality of life was greatly improved. The friend who was 68 took alot longer to heal than the one who was 62. They both now walk 5 miles three times a week with no problem. This is anticdotal info but something to consider.

[bkcunningham1]

Currently, it would depend on what type of insurance you have if you can get knee replacements. Your private insurance carrier should already have it spelled out for you what they will or won't pay for. The policy tells you what is covered and what isn't covered, what is elective and what isn't elective. Most insurance company's determination is based on the reason for the surgery and what therapies (medications, exercise, knee braces, etc) have been used leading up to a determination by a physician for knee replacement surgery, and even what type of knee replacement surgery your doctor recommends. There are several types of knee replacement surgeries.

If you have government insurance like Medicare in Florida, knee replacement is considered "lower limb prosthesis." Here is a link to current info about Florida Medicare coverage for lower limb prosthesis:

http://www.medicare.gov/coverage/Search/Results.asp?State=FL%7CFlorida&Coverage=128%7CLower+Limb+Prostheses&submitState=View+Results+%3E

Here's the main page to look up your state and coverage with Medicare.

http://www.medicare.gov/coverage/home.asp

The way I understand (which is very little) the new Healthcare Reform Act, it mainly forces everyone to have insurance coverage one way or another. Either privately (self insured or through your employer), through a government subsidized state run insurance pools, Medicare, Medicaid et al, or be fined if you don't.

You have to have insurance. Period. What the insurance covers and how much it pays isn't entirely addressed, yet. They aren't going to start giving you free coverage and cover 100 percent for nothing. The federal government has set up a board (a watchdog group basically) to study what is being covered, costs and so forth and to make recommendations.

From the government website:

http://www.healthreform.gov/about/answers.html#consumers

Q: I have a pre-existing condition. How can I get coverage this year?

A: This year, if you have been uninsured for 6 months and have a pre-existing condition, you will gain access to health insurance that was not previously available to you. ..

A new program – known as a high-risk pool – will provide affordable insurance for Americans who are uninsured and have a pre-existing condition. This program will provide temporary protection for people with pre-existing conditions until 2014, when insurance companies can no longer deny you coverage based on your health.

Q: Can I join a pool now to lower my costs?

A: Beginning in 2014, reform will create state-based health insurance exchanges that pool small businesses and their employees, which will spark competition and give you the kind of purchasing power that big businesses enjoy today. The exchange will offer the same types of private insurance choices that the President and Members of Congress will have. Increased purchasing power and competition will make premiums more affordable. The exchange will also reduce administrative costs for your businesses and your employees, enabling them to easily and simply compare the prices, benefits, and quality of health plans.





Q: My insurance company wants to raise my rates. What recourse do I have?

A: For most consumers today, it is hard to figure out how to challenge a rate increase. The new health insurance reform law will create a clear pathway for consumers to hold insurance companies accountable.

In 6 months, all new health plans will be required to have implemented a clear and effective process under which policy holders can appeal coverage determinations and claims. States must also have an external appeals process to ensure a fair and objective review of coverage disputes.

Additionally, millions of dollars in grants will be made available this year to states to help create a health insurance consumer assistance office where consumers can learn how to enroll in a plan or file a complaint. There will also be a new website that will begin operating this year, which will help consumers identify and compare health coverage options. Information will be presented in a standardized, easy-to-understand format to ensure that individuals and families understand their options and purchase the right coverage for their needs.

Finally, new standards for the amount an insurance company must pay out in benefits as opposed to profits and administrative expenses will go into effect in 2011. Insurance companies will be required to give money back to consumers if they do not meet those standards. In addition, requested premium increases will be made publicly available, and in 2014, plans that have arbitrarily raised rates previously may not be able to participate in the new health insurance exchanges.

[Lou Card]

BK Cuningham 1

Well said sir and wonderful information. I sure do love facts over fear. Thank you for your post.

Lou

[TrudyM]

BK Cuningham 1

Well said sir and wonderful information. I sure do love facts over fear. Thank you for your post.

Lou

DITTO:agree:

[Pturner]

Great info BK (cuz). Thank you.

[Peazoup]

bkcunningham1 - good stuff. Thanks so much.